Hospitalists Malpractice Insurance
Hospitalists play a relatively new but rapidly growing role in the American healthcare system, and research has shown that Hospitalists reduce the length of hospital stays, reduce treatment costs and generally provide more efficient care for hospitalized patients.
As a relatively new specialty, many malpractice insurers do not have a separate designation for Hospitalists, and generally group them together with internists, though there is a trend toward a separate classification for Hospitalists. In 2009, The Doctors Company, one of the nation’s large malpractice insurers, began underwriting Hospitalists as a separate group. As in internal medicine, premiums for malpractice insurance in hospital medicine will be toward the lower end of the spectrum. Factors that cause variation among individual physicians’ premiums include geographic location, specific procedures performed, number of hours worked per week, previous claims history and other details of the practice. Most Hospitalists are hospital employees and are covered by insurance purchased by the hospital, but all physicians in the specialty should be aware of the terms and limits of their coverage.
Because Hospitalists are part of a growing field and in high demand, the specialty is unusually mobile. This mobility creates a higher-than-usual risk of facing a gap in coverage and Hospitalists are often forced to change insurance carriers. Many malpractice insurance policies are written on a claims-made basis. This means that the policy covers only claims satisfying two conditions: The incident must have occurred after the policy’s retroactive date, and the claim must be filed while the policy is active. This means that, when a physician changes insurance carriers, he must purchase “tail coverage” from the previous insurer, so that he or she continues to be covered in case a claim is filed in the future regarding an incident that occurred during the term of the previous policy. Tail coverage can be expensive, and physicians should research the terms of tail coverage before deciding on a policy. Some carriers will offer retroactive coverage, which makes tail coverage from the previous insurer unnecessary.
Research shows that malpractice claims against Hospitalists are relatively infrequent, though because hospital medicine is a new specialty, it can be difficult to determine exactly how many cases involve Hospitalists. While physicians who practice standard internal medicine are most likely to be sued for failure to diagnose a disease or condition, a suit against a Hospitalist is more likely to be caused by a failure in communication. This is true because Hospitalists do not have the same established relationships with patients as traditional internists. Hospitalists’ primary responsibility is to make sure the patient receives the optimal medical care in a hospital setting, a goal that relies heavily on communication, both with the patient and with other physicians. Good risk management for Hospitalists therefore emphasizes good communication. A good relationship with a patient, in which the patient feels he or she has been listened to and understood, can significantly reduce the likelihood of a lawsuit. Additionally, physicians should follow a set procedure for communicating with colleagues and seeking second opinions; roles and accountabilities should be clearly defined for the entire treatment team.
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Resources for Hospitalists
Evolution of the Hospitalist
Today’s Hospitalist magazine
Society of Hospital Medicine
Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists
Frequently Asked Questions
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I’m employed by a hospital – do I need my own malpractice insurance?
Usually no, but you must understand the limits, exclusions, and what happens when you leave.
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What should I know about my employer-provided malpractice coverage?
Know the limits, exclusions, tail coverage rules, and what happens if you leave your position.
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How does hospital medicine differ from other specialties when it comes to insurance?
Many insurers classify hospitalists under internal medicine, but separate hospitalist classifications are becoming more common.
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How much will I pay for malpractice insurance as a hospitalist?
Premiums are generally low to moderate, similar to internal medicine, but vary by state and procedures.
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What factors will affect my malpractice insurance premium?
Location, procedures performed, hours worked, practice details, and claims history.
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I’m changing jobs – what happens to my malpractice coverage?
You may need to secure tail coverage to avoid gaps when you leave your position.
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What is tail coverage and do I need it when I change jobs?
If your policy is claims-made, tail coverage is required unless your new employer provides retroactive coverage.
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How expensive is tail coverage?
Tail typically costs 150%–250% of your annual premium.
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Are there ways to avoid paying for tail coverage?
Yes, retroactive/prior-acts coverage or occurrence coverage can eliminate the need for a tail.
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What should I ask about tail coverage before accepting a job?
Ask about cost, payment terms, and whether your employer pays for the tail when you leave.
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How often do hospitalists get sued for malpractice?
Claims are relatively infrequent and less common than for procedural specialties.
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What’s the most common reason hospitalists get sued?
Communication failures, especially during handoffs and discharge are the top cause of lawsuits.
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Why is communication such a big risk for me as a hospitalist?
You rely heavily on team coordination and see patients for brief periods, increasing the risk of miscommunication.
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How can I reduce my risk of being sued as a hospitalist?
Prioritize patient communication, structured team communication, and clear documentation.
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What communication practices should I focus on with patients?
Build trust quickly, keep patients informed, and ensure they feel heard.
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How should I manage communication with other physicians and staff?
Use structured communication tools and document all significant handoffs and decisions.
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What’s the difference between claims-made and occurrence coverage, and which is better for my mobile career?
Claims-made requires tail coverage; occurrence does not but costs more upfront.
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Should I get occurrence or claims-made coverage as a mobile hospitalist?
Occurrence is simpler and avoids tail, but claims-made with prior acts coverage works well if managed carefully.
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How do I find the best malpractice insurance for my situation?
Work with a broker who understands hospital medicine and can shop every major carrier.
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Where can I learn more about hospital medicine and my specialty?
The Society of Hospital Medicine and Today’s Hospitalist are top resources.